‘Alarm fatigue' might hinder hospitals' fall prevention

Published: Wednesday, November 21, 2012 at 9:52 a.m.

Last Modified: Wednesday, November 21, 2012 at 9:52 a.m.

When was the last time you tuned out a car alarm? If you're like most people, unless it's your car, probably every time you hear one.

Now imagine those alarms sounding up and down hospital corridors, alerting nurses to patients who get up when they shouldn't, or worse, fall down.

Bed alarms are a growing feature of hospital rooms, but a study published Tuesday in the Annals of Internal Medicine said they might not actually prevent patient falls in hospitals.

According to lead author Dr. Ronald Shorr, the director of geriatric research education at the Veterans Affairs Medical Center in Gainesville and an epidemiology professor at the University of Florida, "alarm fatigue" — the same thing that makes you ignore car alarms — might be occurring in hospitals.

Shorr and his colleagues conducted the study at the Methodist Healthcare University Hospital in Memphis, Tenn., on 16 nursing stations covering 349 beds. The "alarms" are battery-powered pads with sensors on which patients lie or sit. They sound whenever a patient breaks contact with the pads. Bed alarm monitoring units cost an average of $350, plus $23 for each pad, and patients typically use 3-4 pads during a hospital stay, Shorr said.

Over the 18-month study period, the researchers found no difference in fall rates between the control group — beds without alarms — and those with alarms. The researchers concluded that bed alarms could be part of hospitals' fall prevention programs, but might not necessarily solve the problem of falls.

An estimated 1-2 percent of patients fall during their hospital stays, and roughly a quarter of those result in injury. Most falls happen in rehab units where patients are learning to walk, Shorr said. Injurious falls often result in extended hospital stays, costing an average of $4,000 per patient, according to the American Journal of Medicine.

The issue of hospital falls emerged in 2008, when the Centers for Medicare and Medicaid Services classified injurious hospital falls as "never events" — things that should never happen at hospitals, such as sewing up a sponge inside someone during surgery, Shorr said. Medicare and Medicaid have since stopped reimbursing hospitals for costs related to injuries from falls.

As a result, the onus is on hospitals to make sure patients don't fall. At Shands, bed alarms are just one piece of that puzzle, said Dr. Eric Rosenberg, the chief of internal medicine at UF and physician director of quality for the department of medicine.

"We use them as part of a whole group of things in preventative medicine," Rosenberg said, adding that over-reliance on bed alarms could risk creating a false sense of reassurance. "(An alarm) is one of the latest indicators that a patient is about to have an event. You might not get to the patient in time."

Alarm fatigue can set in, especially with so many competing noises in hospital rooms such as pulse and oxygen monitors, Rosenberg said.

"There are a lot of devices and a lot of patients, so there's the risk of sound dispersion," he said.

Instead, Rosenberg, who also teaches the patient safety curriculum at the UF medical school, emphasizes increasing patient functionality to prevent falls. This involves staff more closely monitoring patients' medications, especially ones that make them unsteady, or sedatives. Physical therapists also work with patients at high risk of falling to improve their mobility and strength.

It's not just the elderly who are at risk of falling, Rosenberg added: Patients who have had strokes or seizures, or even young surgery patients eager to get up and walk around, could easily take a tumble.

Only patients at an intermediate or high risk of falling get bed alarms at Shands, but there's no shortage of alarms, Rosenberg said. Alarms rarely go off, but when they do, they are effective, Rosenberg said, adding that falls are rare and injurious falls even rarer, with fall rates declining significantly in the past two years.

Shands also instituted a policy in hospital corridors a year ago to increase awareness and response of alarms.

"If you see something flashing, or hear an alarm, don't pass it by," Rosenberg said. "Oftentimes it's our clerks who catch it if the nurse is busy. We want to make (patient safety) more of a team effort."

<p>When was the last time you tuned out a car alarm? If you're like most people, unless it's your car, probably every time you hear one.</p><p>Now imagine those alarms sounding up and down hospital corridors, alerting nurses to patients who get up when they shouldn't, or worse, fall down.</p><p>Bed alarms are a growing feature of hospital rooms, but a study published Tuesday in the Annals of Internal Medicine said they might not actually prevent patient falls in hospitals.</p><p>According to lead author Dr. Ronald Shorr, the director of geriatric research education at the Veterans Affairs Medical Center in Gainesville and an epidemiology professor at the University of Florida, "alarm fatigue" — the same thing that makes you ignore car alarms — might be occurring in hospitals.</p><p>Shorr and his colleagues conducted the study at the Methodist Healthcare University Hospital in Memphis, Tenn., on 16 nursing stations covering 349 beds. The "alarms" are battery-powered pads with sensors on which patients lie or sit. They sound whenever a patient breaks contact with the pads. Bed alarm monitoring units cost an average of $350, plus $23 for each pad, and patients typically use 3-4 pads during a hospital stay, Shorr said.</p><p>Over the 18-month study period, the researchers found no difference in fall rates between the control group — beds without alarms — and those with alarms. The researchers concluded that bed alarms could be part of hospitals' fall prevention programs, but might not necessarily solve the problem of falls.</p><p>An estimated 1-2 percent of patients fall during their hospital stays, and roughly a quarter of those result in injury. Most falls happen in rehab units where patients are learning to walk, Shorr said. Injurious falls often result in extended hospital stays, costing an average of $4,000 per patient, according to the American Journal of Medicine.</p><p>The issue of hospital falls emerged in 2008, when the Centers for Medicare and Medicaid Services classified injurious hospital falls as "never events" — things that should never happen at hospitals, such as sewing up a sponge inside someone during surgery, Shorr said. Medicare and Medicaid have since stopped reimbursing hospitals for costs related to injuries from falls.</p><p>As a result, the onus is on hospitals to make sure patients don't fall. At Shands, bed alarms are just one piece of that puzzle, said Dr. Eric Rosenberg, the chief of internal medicine at UF and physician director of quality for the department of medicine.</p><p>"We use them as part of a whole group of things in preventative medicine," Rosenberg said, adding that over-reliance on bed alarms could risk creating a false sense of reassurance. "(An alarm) is one of the latest indicators that a patient is about to have an event. You might not get to the patient in time."</p><p>Alarm fatigue can set in, especially with so many competing noises in hospital rooms such as pulse and oxygen monitors, Rosenberg said.</p><p>"There are a lot of devices and a lot of patients, so there's the risk of sound dispersion," he said.</p><p>Instead, Rosenberg, who also teaches the patient safety curriculum at the UF medical school, emphasizes increasing patient functionality to prevent falls. This involves staff more closely monitoring patients' medications, especially ones that make them unsteady, or sedatives. Physical therapists also work with patients at high risk of falling to improve their mobility and strength.</p><p>It's not just the elderly who are at risk of falling, Rosenberg added: Patients who have had strokes or seizures, or even young surgery patients eager to get up and walk around, could easily take a tumble.</p><p>Only patients at an intermediate or high risk of falling get bed alarms at Shands, but there's no shortage of alarms, Rosenberg said. Alarms rarely go off, but when they do, they are effective, Rosenberg said, adding that falls are rare and injurious falls even rarer, with fall rates declining significantly in the past two years.</p><p>Shands also instituted a policy in hospital corridors a year ago to increase awareness and response of alarms.</p><p>"If you see something flashing, or hear an alarm, don't pass it by," Rosenberg said. "Oftentimes it's our clerks who catch it if the nurse is busy. We want to make (patient safety) more of a team effort."</p><p><i>Contact Kristine Crane at 338-3119 or kristine.crane@gvillesun.com.</i></p>